robot-assisted vitreoretinal surgery & retinovascular surgery · da vinci robot in...
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Confidential, Patents Pending, Copyright Columbia University 2008
Robot-Assisted Vitreoretinal Surgery
& Retinovascular Surgery
12/19/2008
ARMA – Advanced Robotics and Mechanism ApplicationsColumbia University
Nabil Simaan PhD – ARMA, NYHoward Fine, MD MHSc – Harkness Eye Instititue, Columbia, NY
Hari Sundram, MD – Medical Capital Advisors, Boston
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Confidential, Patents Pending, Copyright Columbia University 2008
CONFIDENTIALITY
• This presentation covered by signed NDA• All the material presented in this document is protected
by one or more provisional patents • The material is provided for an overview of our recent
work at ARMA. • Please do not share this document with anyone else
without a written permission of Dr. Simaan (email ns2236@columbia.edu)
• Copy ns2236@columbia.edu on all correspondence related to this material
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Confidential, Patents Pending, Copyright Columbia University 2008
Y. Chen Ph.D.
A. Salerno, Ph.D.
1/05 9/05 9/079/06 1/071/06 3/08 6/08 9/08J Ding Ph.D.
A. Bajo Saleem Hamid
Roger Goldman
Jian ZhangWei2Kai
Xu
Res
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MIS of Throat & Smart Surgical Devices
Robotic Center for High-Throughput Biodosimetry
Cochlear Implant SurgeryDesign and optimal Path planning for under actuated robots
Less Invasive (Single Port)With sensory assistance
MicrosurgeryDesign of Flexible Parallel Robots
ARMA’s Research Activity
Confidential, Patents Pending, Copyright Columbia University 2008
ROBOTS IN OPHTHALMOLOGY
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Confidential, Patents Pending, Copyright Columbia University 2008
Robot-assisted surgery
• Has numerous potential advantages / applications Improved precision over human hands Tremor reduction / elimination Increased dexterity Reduced complication rates Potential to make good surgeons great Potential to expand the capabilities surgeons
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Confidential, Patents Pending, Copyright Columbia University 2008
Robot-assisted surgery
• Examples: Urology – cut rate of impotence / incontinence by 30% in
nerve-sparing radical prostatectomy NOTES – natural orifice transluminal endoscopic surgery
– allows laparoscopic surgery without visible incisions Sansei robot allows remote-controlled cardiac catheter
ablation, EP cardiologist no longer exposed to radiation
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Confidential, Patents Pending, Copyright Columbia University 2008
Robotic-Assisted Ophthalmic Surgery
No intra-ocular dexterity. No manipulation/stabilization of eye under microscope
Grace et. al. 1995. Bilateral manipulation, parallel robot, cannulation.
Wei-Tech, Cam Riviere Hand-held device, tremor cancellation, force sensing
Taylor et. al 1999Cooperative manipulation. Tremor filtering, virtual fixtures
Das et. al 1996/NASA JPLMicro-Dexterity Systems
Mitsuishi 1996 hand-held device with wrist
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Confidential, Patents Pending, Copyright Columbia University 2008
Da Vinci Robot in Ophthalmology
BJO 2007 Jan;91(1):18-21
Retina Today May/June 2008
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Confidential, Patents Pending, Copyright Columbia University 2008
Expand surgical armamentarium
• Retinal vascular surgery Apply techniques / technology of interventional cardiology
toward retinal vascular diseaseCannulationStentingAngioplasty
• Drug delivery• Membrane peeling (PVR, etc…)• Sub-retinal surgery (RPE cell transplantation, etc…)• Others…
Confidential, Patents Pending, Copyright Columbia University 2008
ROBOT DESIGN
Dual-Arm Robotic System for Ocular manipulation and Intraocular Dexterity
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Confidential, Patents Pending, Copyright Columbia University 2008
Two Armed Slave Robot for μ-surgery of the eye
Microscope view cone
Adjustable arm w. fast lock
6-DoF parallel robot with a stage and a intraocular dexterity device
Stereo-tactic frame with dental lock
Confidential, Patents Pending, Copyright Columbia University 2008
VIDEO 1: see movie 2 in web page
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Confidential, Patents Pending, Copyright Columbia University 2008
Dual-arm micro surgery
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Confidential, Patents Pending, Copyright Columbia University 2008
Dual-arm micro surgery
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Confidential, Patents Pending, Copyright Columbia University 2008
Preliminary Experiments
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Confidential, Patents Pending, Copyright Columbia University 2008
Retinal vascular stenting
• Apply techniques / technology of interventional cardiology to retinovascular disease
• Retinal vascular stenting (i.e. to treat BRVO)
Ophthalmology. 2001 Dec;108(12):2249-57
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Confidential, Patents Pending, Copyright Columbia University 2008
Venous stenting in humans
• Venous stenting in humans has been performed extensively Portal vein stenting
TIPS procedure: transjugularintrahepatic portosystemicshunt relieves cirrhotic
Following deep vein thrombosis Chronic deep venous obstruction:
definition, prevalence, diagnosis, management. Phlebology. 2008;23(4):149-57
Peripheral vascular disease Venous stenting across the inguinal
ligament. J Vasc Surg. 2008 Nov;48(5):1255-61.
• Obstacles in retinal venous stenting Bleeding
Control with IOP on tamponade Thrombosis
Many retinal veins recanalizeWR Green, Histopathologic
study of nine branch retinal vein occlusions, Archives 1982
Stent “re-stenosis” Low flow system less likely
Stent displacement
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Confidential, Patents Pending, Copyright Columbia University 2008
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Confidential, Patents Pending, Copyright Columbia University 2008
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Confidential, Patents Pending, Copyright Columbia University 2008
Placing a 200m Stent in a CAM blood vessel
Dual-arm placement of a micro stent (4/2/08)
Single-arm placement of a micro stent (4/18/08)
Confidential, Patents Pending, Copyright Columbia University 2008
Movie 3: stenting apparatusMovie 5: Stent experiment 2
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Confidential, Patents Pending, Copyright Columbia University 2008
Points of Contact
• For questions about the technology please contact:Nabil Simaan (Assistant Professor, Mechanical Engineering)Columbia University234 S.W. Mudd Building, Mail code 4703500 West 120th street, New York, NY 10027email: ns2236@columbia.edu phone: +1-212-854-2957
• Note: please copy ns2236@columbia.edu on ALL inquiries
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